Author: Tom

Your Company Name Here
Date: ________________ STRAIGHT BILL OF LADING DRIVER: ___________
Terminal: _____________ ORIGINAL —NOT NEGOTIABLE Truck: ______________
Load: ________________
SERIAL #: __________________

CARRIER: Your company name here US DOT: ________
P.O. Box xxxxx MC-ICC : __________
City: _____________

FROM: Shipper Address (Origin) TO: Consignee Address (Destination)
___________________________ ___________________________
___________________________ ___________________________
City:__________________ State:_____ CITY:_______________ State:____

FOR PAYMENT: NO Driver Damage
Remit C.O. D. Damage noted: ________________________
Remit ½ payment prior to shipping: ___________________________

Description Weight Rate Miles Total
_______________ ________ $______ _______ $___________

ACT OF GOD: If shipper declines Act of God waiver, put no here:_______________
Units for living purpose exclusively: Unless a grater value for the household and personal effect and/or furnishing, not a part of the unit, at point of manufacture include in this shipment, is declared on this Bill of Lading the shipper hereby releases such property to a value not exceeding. Two Hundred Fifty Dollars ($250.00). $__________ Signed: ___________________.
Units for purpose other than living purposes exclusive. Unless a greater value per unit and equipment is declared on this Bill of Lading, the shipper hereby releases this shipment to a value not exceeding Ten Thousand Dollars ($10,000.00) for each unit and equipment contained therein transported. I declare the excess valuation of personal effects and furnishings to be $________________. Signed:____________________________
Shipper or Agent: I hereby authorize this shipment and make the declaration of values (if any) and agree to the contract terms and conditions hereof Signed:________________________ Date:_________________
Carrier Agent: Forgoing shipment subject to declaration (if any) or release terms and conditions herein, Your Company name (if No Signature, Need Pro Bill#). Signed____________________. Date:_____________.
Payor/Shipper is liable for all (1) structural and mechanical failure related directly to pay for/shipper’s equipment as per Section I (d) of Terms and conditions (2) tolls, permits and state fees as per applicable tariff:
C.O.D FEE: _____________ PREPAID: $_____________ COLLECT: $_______________ THIRD PARTY:__________
Subject to section 7 of conditions if the shipment is to be delivered to the consignee with out recourse on the consignor, the consignor shall sign the following statement. The carrier shall not make delivery of this shipment without payment of freight and all other lawful charges.
Signature of Consignor: ____________________________________
Delivery Release: I request the Carrier park unit at delivery site and I release Carrier and Driver from any damages resulting from off road parking, which could be total destruction. Signature: ___________________________ Date:________________________
Note: This is a release to carrier for all damages and shortages unless noted hereon. No claims for any loss, damage, injury or delay will be paid unless all lawful charges have been paid to carrier.
SHIPPER: CARRIER: CONSIGNEE:
PER:______________________ PER:______________________ PER:________________________

RECEIVED the property described below, in apparent good order, except as noted (contents and conditions of contents of packages unknown). Marked, cosigned, and destined as shown above, which said carrier (the word carrier being understood throughout the contract as meaning any person or corporation in possession of the property under the contract) agrees to carry to its usual place of delivery at said destination, if on its route, otherwise deliver to another carrier on the route to said destination. It is mutually agreed, as to each carrier all or any of said property over all or any portion of said route to destination, and as to each party at any time interested in all or any said property, that every service to be performed hereunder shall be subject to all terms and conditions of ________ Rules Tariff. Shipper hereby certified that he is familiar with all the terms and conditions of the said bill of lading, including those in _________ 101 Rules Tariff.